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NON-HAZARDOUS WASTE MANIFEST <br /> 111098@ pnnl or type {Farm dasiGnOd IOr use on elite(12 Dfth)typowmer) <br /> NON-HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 <br /> WASTE MANIFEST Document No, <br /> I of <br /> 3.Generator's Name and Mailing Address -" �- C` <br /> �. <br /> - <br /> `? 4,Generator's Phone( ) �,��I� '•� C'!.I 1, � <br /> Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> B.Transporter 1 Phone - <br /> 7.Transporter 2 Company Name 8 US EPA ID Number C.State Transporler's ID <br /> D.Transporter 2 Phone <br /> + 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> F Facility's Phone _ <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14 <br /> Total Unit <br /> No Type Quantity W1.1vol. <br /> a <br /> G b <br /> E <br /> N <br /> E <br /> R c- <br /> A <br /> T <br /> 0 <br /> LV R d. <br /> N <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> NQ i 15.Special Handling Instructions and Additional Information <br /> r i <br /> Z _ <br /> 0 <br /> Z <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Date <br /> A Printed/Typed Name Signature <br /> N [_ �_ _ �s �, ,_,F� �rq. - Month Day Year <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Date <br /> Printed/Typed Name <br /> TSignature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L N5 r <br /> Date <br /> T Printedlfyped Name Signature Month Day Year <br /> Y ��,; C F 1.E�;�:� l.,'`�-s ,�Ui�,-��` j`,v_.. •�; ��_�? �``'I � , �-_ ,,� <br /> F-14 02002 LABELMASTER® (800)621-5806 www.labelmaster.com <br /> Rev,3/95 <br />